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PENNY GOUDELOCK PA
NPI 1043433352
Physician Assistant - Medical in Everett, WA

Active since April 11, 2007PECOS Enrolled
1100 PACIFIC AVE, SUITE 202, EVERETT, WA 98201(425) 388-4075 Get Directions Write a Review

NPPES record last updated: April 14, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Penny Goudelock Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PENNY GOUDELOCK PA (NPI 1043433352) is an individual medical provider in Everett, Washington, licensed in Washington (PA10005160) and active in the NPI registry since April 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1043433352
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NamePENNY GOUDELOCKCredential: PA
Location Address1100 PACIFIC AVE, SUITE 202Everett, WA 98201-4261
Mailing Address18012 W Valley Hwy, Ste 101Kent, WA 98032-2924 · (425) 291-3300 · Fax (425) 291-5300
Phone(425) 388-4075
Sole ProprietorNo
Enumeration DateApril 11, 2007
Last NPPES UpdateApril 14, 2020
NPPES CertifiedApril 14, 2020
✔ NPI 1043433352 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in WA · PA10005160
1100 PACIFIC AVE, Everett, WA 98201
Open in Google Maps ↗

Other Identifiers 1

Medicaid8485898WA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Premera Blue Cross Blue Shield of Alaska, Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Penny Goudelock Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JOHN D PRYOR M.D.
Orthopaedic Surgery
1100 PACIFIC AVE, SUITE 300
EVERETT, WA 98201
Snohomish County (425) 339-2433
DR. RICHARD L SEMON MD
Orthopaedic Surgery
1100 PACIFIC AVE, SUITE 300
EVERETT, WA 98201
Snohomish County (425) 339-2433
DR. PETER J. KINAHAN M.D.
Orthopaedic Surgery
1100 PACIFIC AVE, SUITE 300
EVERETT, WA 98201
Snohomish County (425) 339-2433
DR. ROXANNE E HERTZOG M.D.
Anesthesiology
1100 PACIFIC AVE, SUITE 100
EVERETT, WA 98201
Snohomish County (206) 244-1212
MONO NHEAN OT
Occupational Therapist
1100 PACIFIC AVE, SUITE 201
EVERETT, WA 98201
Snohomish County (425) 374-2846
DR. DOUGLAS D NOWAK M.D.
Orthopaedic Surgery
1100 PACIFIC AVE, SUITE 300
EVERETT, WA 98201
Snohomish County (425) 339-2433
DR. HOWARD BARNUM BARKER MD
Orthopaedic Surgery
1100 PACIFIC AVE, SUITE 300
EVERETT, WA 98201
Snohomish County (425) 339-2433
DR. RALPH T. HALLER M.D.
Orthopaedic Surgery
1100 PACIFIC AVE, SUITE 300
EVERETT, WA 98201
Snohomish County (725) 339-2433

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Penny Goudelock's NPI number?

The NPI number for Penny Goudelock is 1043433352. It was assigned to this individual provider in the NPPES registry on April 11, 2007.

Where is Penny Goudelock located?

Penny Goudelock practices at 1100 Pacific Ave Suite 202, Everett, WA 98201. The listed phone number is (425) 388-4075.

What is Penny Goudelock's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Penny Goudelock enrolled in Medicare?

Yes. Penny Goudelock is registered in the Medicare PECOS enrollment system.

What insurance does Penny Goudelock accept?

Health plans from Premera Blue Cross Blue Shield of Alaska and Providence Health Plan list Penny Goudelock as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Penny Goudelock was last updated on April 14, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.